06-100390 ' • REC IV
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GTYOF `*-, "AN262 112, - _11) 0qD
Federal way 1D1 ' MIT /
CITY o SF MF CO ME EL PL DE E
COA4MUNI'IYUEVELOPME7dTSERVIC'ES M��G,. 414
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33325 BTIa AVENUE SOUTH•PO BOX 97I8 �
FEDERAL WAY.WA 98063-9718 APPLI CATI O I ,9P
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253-835-2607•FAX 253-8.35-2609
www.cituoffederatwau.corn
The ollowin• is re•aired i ormation-an incom•tete a••lication will not be acce•ted. Please •rint le•ibl an ink)or •e.
al PROPERTY INFORMATION t
SITE ADDRESS `t 10 ctta AJt 5 SUITE/UNIT# 114
3 2
ASSESSOR'S TAX/PARCEL# A Z (€ 4 b C) - 0 6 ck
SyCS LOT SIZE (sj)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) WC'it CiAJv.4 skS %aS.At".% C toJ k. 1\-0It
!Attach separate prageJbr Ien9thy Lryat deariplk,N
11111 PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING X FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onItj)
f ej . I E X,Cev,Gljt>yts` i,n i C: 4e ri`a 4 ...i sA,{"v', -c-vt te.crnk +Aisi);"--;evvtxi/It •
PROJECT NAME(Name of Business or Owner Last Name) V-i•' t:Lc Ce vv. 14 et y
is PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER f eGf v„c..,i -ss od.,z a S f 610 C-�rk+M-mr 6.ev.. .tvwesttfir Y (206 ) `Li4 _4ed,i .
MAILING ADDRESS CITY.STATE,ZIP
'‘St); **icJ c 1-‘,•e 0 - 5 ti Lite i'WA 1 f3 i Q q
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE`
A Cli vw ce'w o ( 7 ,0 ) 4 l3 - 61
fie✓ ( 1�-t. �G�wt�S 'Fa,s.e'� � 0'7
MAILING ADDRESS CITY,STATE.ZIP CELL PHONE
Pc zttis 340'1 Lite<1 1 wA Ci 6' 0 -3401 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER.
Z to -Q CI - ( it i '1 5' Z - BL 17 / 3 t / e i ( 3U° ) 43 e - AZ14
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
, AL 12 1111 L £ 0 c 5- C ") 1: / t(0, / c.,.7
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
S Gt v`1,e A S C c A 64-Ta(3.-6 ( ) -
MAILING ADDRESS CITY.STATE.ZIP CELL PHONE
( )
RELATIONSHIP TO PROJ ECT FAX NUMBER
0 Architect 0 Tenant 0 Agent ❑ Other(Describe) ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
,3 cm-.e s Fa4;5 'k* (7 ) i 13 - ‘l e./
LENDER Per RCW 19.27.095: Lender informltt,ion is NAME
required if project value exce•• •$5,.099-' .old,,t/ ,L., 1 I/it/`_...ird !ye✓ �, i.6"le
.
MAILING ADDRESS ---"- CITY,STATE. le PHONE
( )
U DETAILED BUILDING INFORMATION
EXISTING USE 4" (-'t ( 51 vi i•,rC-h Se- PROPOSED USE .a vv1 6
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ (-03 t 1 • 0 t='
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
•
w •
•
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ. FT. SQ. FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DES t. BE)
DECK(COVERED?)
f'
i
GARAGE ❑ CARPORT❑ ,'r
NUMBER OF FLOORS EXISTING •'POSED ' TOTAL TOTAL COMM S TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of-each type of fixture o be installed or relocated as part this protect. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $___ ---
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(Comrnrrct:il) _ WOODSTOVFS
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHT S or Tub/S,owerCombo) SHOWERS WATER CLOSETS rn,n t) MISS Describe)
DIS ASHERS SINKS DRINKING FOUNTAINS
S PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS[Bathroom SRilcH) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
I am authorized by the owner of the above premises to perform the work for which the permit application is made. I further agree to hold
harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred in the investigation and defense of
such claim),which may be made by any person,including the undersigned, and filed against the City of Federal Way,but only where such claim
arises out of the reliance of the city,including its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application. ^�i-
NAME/TITLE DATE I J c C, /oh
TS ature) rT�ue)
RELATIONSHIP TO PROJ ❑ Owner ❑Agent. 'X'Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY .
o NEW ❑ADDITION a ALTERATION o REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES a NO BASIC PLAN? a YES ❑NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? ❑YES a NO UP/SEPA/SU? ❑YES a NO
PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? a YES ❑NO